The Cost of Care


Nashville’s Ronald McDonald House sits on a quiet corner of Fairfax Avenue, within two miles of the city’s three major hospitals.

For many pediatric patients and their families, the House is a home away from home during a crisis.

With Vanderbilt’s reputation for pediatric care on the rise, the need for the Ronald McDonald House is greater than ever. The House’s 32 rooms are full every night of the year.

But while the families who stay in the House each night face massive medical bills, the House itself also faces the hard task of providing for those families in a struggling economy.

Perhaps nobody understands that better than Marsi Shelton, 34, a longtime volunteer and current board member for the House.

When Shelton’s daughter Katelyn was just four months old, doctors discovered the baby had craniosynostosis, a rare birth defect that prevents the brain from growing naturally.

Katelyn would need surgery to correct the defect, and her family was devastated.

“I don’t think anything in the whole wide world’s ever happened that would be this bad,” Shelton said she remembered telling her mother.

Katelyn’s first surgery was scheduled for October, the day after the House’s annual golf tournament, which Shelton had been planning.

“When the golf tournament was over and I went to leave, I guess the reality of it all just set in right at that moment,” Shelton said. A member of the staff hugged her goodbye and she broke down.

“It was the last thing I was going to do before I went home and had to wake up the next morning and take her into surgery,” she said.

That night, the Sheltons moved into the House.

The average stay at the House is about 30 days, and it costs the House about $83 a night to provide for one family, said Kirra Menees, 47, the House’s volunteer coordinator.

Though families are encouraged to donate $15 for each night during their stay, “no one’s turned away if they can’t afford that fee,” said Menees.

Right now, none of the 32 families staying there can.

“They’re facing tens of thousands of dollars, if not hundreds of

thousands of dollars in medical bills, and it’s a hard conversation to bring up,” said Diane Hargrove, 32, a volunteer and board member. “They’re putting their focus where it needs to be: on the child who’s sick.”

During Katelyn’s hospital stay, Shelton and her family lived in the House for a week, and Shelton began to appreciate the House’s work in a new way. Even the simplest things, like the opportunity to take a hot shower, became a blessing.

“You’re lucky if you get that at the hospital because they only allow showers at certain times of day with certain people that are in their overnight rooms,” Shelton said. “You could go home and take your shower, but I was not leaving my baby laying there either to go home.”

Shelton stayed in Katelyn’s room overnight while her husband slept in the family’s room at the House, which allowed them both to get some much-needed rest.

“You need to be able to understand what the doctors are telling you about what’s going on with your child and make good decisions about it, and to me, if you’ve stayed up five days straight, that’s just not happening,” she said. “There’s just no way you can think clearly when you’re going on next to no sleep.”

Of course, providing a place for 32 families to sleep every night isn’t cheap, and with so few residents able to contribute even $15, the task of paying the bills falls to the House’s seven-person staff.

“We’re small but mighty,” Menees said. “We all fundraise to some extent.”

One of the biggest misconceptions about the House is its funding comes directly from the McDonald’s corporation, Menees said.

The fast food chain provides an initial seed grant to start a House, and every year, restaurants celebrate McHappy Day, encouraging customers to donate $1, $3 or $5 to support Ronald McDonald House Charities. The money raised by every McDonald’s location in a particular country is distributed evenly between all the Houses in that country.

But beyond that, “we do have to raise all the funds that are required to keep our doors open,” Menees said.

“Our house is a lot like your house; it’s just everything’s on a larger scale,” Menees said.

The House’s water bill alone is about $2,000 a month, roughly 40 times that of an average Nashville household, according to 2010 data from Metro Water Services.
House residents also consume 2,500 cases of Coke products a year, and they collect the pull tabs off each can to raise more money for the House, though it may not be much.Even the most inexpensive items add up – the amount of toilet paper the House uses each year “would reach across the length of the United States,” Menees said.

“A donation of thousands of pounds of pull tabs pays for maybe a couple months or two of utilities, and that’s it,” said Hargrove.

Still, the House’s financial battle pales in light of the challenges its residents face, Hargrove said. “What’s frustrating to you in your daily life is nothing compared to what these families are going through.”

Katelyn Shelton is now a happy, healthy 3-year-old, but her mother said a place of rest like the House is even more important to families whose children have long-term illnesses.

“We were at the hospital for seven days, but for the people that are staying for months on end, I just can’t imagine that they would have to function like that,” she said. Without the House, “they would have to just live literally out of a suitcase all the time.”

The House also helps families while they’re at the hospital. Click to see an audio slideshow of a recent family dinner night.

And Menees said knowing the House makes a difference for families in crisis keeps the staff going when finances are tight.

“You’re feeding your family, the medical bills are piling up, you have electricity and water – none of those things are going away,” Menees said of the House’s residents. “So if we can provide that little bit of respite, then that’s what we are here for.”


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